Infant Toddler Development TrainingModule 6, Lesson 2

Nutritional Concerns of Premature Infants

Premature (pre-term) infants are infants who are born before 37 weeks of gestation. Those born prior to 32 weeks are more vulnerable to nutrition issues. Often pre-term infants have a lower mineral content in the bones which may lead to brittle bones and bone fractures. These infants are at a higher risk for anemia. Premature infants cannot take in as many nutrients as the full-term infant and most of the formulas are based on the daily needs of the full-term infant. Therefore pre-term infants may need special formulas or supplements in their formulas. Pre-term infants need to have "catch-up" time, usually 9 – 12 months after birth. "Catch-up" refers to the time needed to gain weight in excess of that expected for their gestational (adjusted) age. Pre-term infants who can catch-up on weight and growth show improved health and developmental outcomes. Some "catch-up" may occur up to the eighth year of age.

Premature infants need a high nutritional formula at least until they are about nine months old. A nutritionally rich diet, which may include a prescribed, specially enriched formula, or breastfeeding, perhaps with a physician prescribed supplement, is of vital importance during this first year of life. This is when the brain is growing rapidly and making the most neuronal connections.

Premature babies have their weight, length, and head circumference plotted on a growth chart for premature infants. The BMI should always be plotted to ensure growth in body, muscle, and fat. After 9 – 12 months a switch to a regular growth chart can be made if the infant is showing a BMI or weight for length of the tenth to twenty-fifth percentile for a typical infant.

How can an ITDS support young mothers who have premature infants to ensure that the nutritional needs of the infants are met?

Studies of premature babies have shown that they do better in a quiet, calm environment where lighting and noise levels are controlled. Even when they must take their feeding through a feeding tube, the infant may learn to self regulate its neurological state better if they are provided with a non-nutritive sucking experience such as with a pacifier during the feeding. Premature infants sometimes have to be fed with a tube inserted through the nose, a naso-gastric tube or a tube inserted through the mouth, an orogastric tube. In some cases a feeding tube must be inserted directly into the stomach through a surgical opening created in the abdomen. This is a g-tube or gastrostomy tube.

Weaning from Tube Feeding

There are several suggested interventions to wean a premature infant from gastrostomy tube feeding to oral feeding. They include:

Limit the number of caregivers who provide the feeding to the infant.

Minimize distractions at feeding time.

Attempt to normalize a feeding schedule with boluses provided after oral feeding has been attempted. A bolus is a small mass of food prepared for swallowing or for insertion into a feeding tube to ensure that an infant receives appropriate nutrients. It is important to note that solid food must be liquefied per a physician's instructions. Usually a bolus refers to a liquid such as formula or water that is given all at once, rather than via a feeding pump over time. The ITDS should not provide gastrostomy tube feeding unless appropriately instructed by the primary care physician.

Maintain gentle yet firm and consistent handling during feeding. Premature infants like a firm touch that is not tentative.

Reward the acceptance of food.

Ignore refusals of food.

Remember to use the adjusted age when determining when to start the baby on solid foods.

Immature Bowels in Premature Infants

Some premature infants have such immature bowels that they cannot digest food. Sometimes their bowels become necrotic (tissue or cell death) if fed much too soon, if an infection occurs, or if the bowel is malrotated. When necrosis occurs, the infant may require surgical removal of a large portion of the bowel. This is referred to as short gut syndrome. The infant survives with parenteral nutrition. If the infant has lost the ileocecal valve the result is decreased fluid and nutrient absorption and also bacterial overgrowth. The physician and nutritionist assist the infant in this situation by introducing oral nutrition when the infant's bowel is more mature. Oral nutrition helps to stimulate bowel growth and this increases absorption. Hydrolyzed proteins also help absorption. Carbohydrates are often reduced as they cause diarrhea that can result in even more malabsorption.

There are excellent on-line resources for the parent who has a child in the neonatal intensive care unit (NICU). One website provides information regarding nutrition, diagnoses common in the NICU, terminology, and the transition home. Please see Kids Health This site also provides information on assistive technology and chronic illnesses, such as cystic fibrosis, that affect the nutritional status of children.